Beginning Jan. 1, 2022, specific UnitedHealthcare Medicare Advantage plans in Alabama, Illinois, Oklahoma and Texas will manage patient hospice care through the Centers for Medicare & Medicaid Services (CMS) Value-Based Insurance Design (VBID) program.
Through this pilot program, UnitedHealthcare will work with you and your patients to ease the transition from medical treatment to palliative and hospice care. Your patients can receive pre-hospice consultation, plus more timely access to the Medicare hospice benefit. And, they may be eligible to continue receiving some transitional curative care services.
The designated Medicare Advantage and Dual Special Needs Plans (DSNP) below are in states and jurisdictions where UnitedHealthcare has been approved to offer this plan benefit starting January 1, 2022.
|State||Area||Centers for Medicare & Medicaid Services (CMS) contract|
H0432-003-000, H0432-004-000, H2802-041-000, H6528-033-000, H0432-012-000, H0432-010-000, H0432-009-000, H2802-044-000, H0432-013-000
NEW 2023: H1889-009-000
H3749-001-000, H3749-017-000, H3749-018-000, H3749-020-000, H8768-008-000, H8768-009-000, H8768-016-000, H8768-028-000, H5322-031-000
NEW 2023: H0271-053-000, H5322-033-000
For WellMed impacted plans, billing instructions, provider eligibility and other details, please reference https://www.wellmedhealthcare.com/hospicevbid/.
For this pilot program, the WellMed information takes precedence over UnitedHealthcare processes and guidelines – the information provided on uhcprovider.com/mahospice applies only to Alabama, Oklahoma and Illinois.
Here’s how to check if a patient is currently enrolled in one of the designated plans:
Limited to hospice providers that are contracted (participating) with UnitedHealthcare for Medicare in the designated states.
Patients who elect hospice at an in-network provider may have the option to continue some short-term curative services after they elect hospice.
Any hospice providers that are NOT contracted with UnitedHealthcare for Medicare will be considered out of network. Patients who are part of the plans listed above can still choose to elect hospice care at out-of-network hospice providers that are Medicare-certified.
Referrals and prior authorizations are not required for members to receive hospice care.
Send all notices and claim submissions to both UnitedHealthcare and the CMS Medicare Administrative Contractor (MAC).
CMS created the Value-Based Insurance Design (VBID) model for hospice care as part of its commitment to innovation. By creating a more coordinated transition into end-of-life care, we can create a better path for patients and their families to use hospice care in a way that best meets their needs.
Under the VBID model and in states and jurisdictions where UnitedHealthcare has been approved to offer such benefits:
Hospice care navigation
Members can choose to have a pre-hospice consultation to help understand their in-network and out-of-network hospice options. To request a consultation, members should call the number on the back of their ID card.
Transitional concurrent care
To help ease the transition to hospice care, members who select a hospice in the UnitedHealthcare network may be eligible to continue a subset of short-term curative care services. As required by CMS, this is only available to members covered by one of the UnitedHealthcare designated VBID plans and elect hospice at an in-network provider. Transitional concurrent care services are not covered if a member chooses an out-of-network hospice provider.
If it is determined that Transitional Concurrent Care is appropriate for a member, in-network hospice providers must:
For questions on transitional concurrent care, hospice providers can call 833-753-2970.